The use of medicines impacts every aspect of healthcare and is also the most costly component of healthcare behind salaries and estates. The scale, cost and risk of this one area of healthcare means that small improvements can deliver big transformation.
In South Africa, the push to provide improved health services to previously disadvantaged parts of the population, while simultaneously reducing the overall cost of healthcare, has led to an increased focus on using medicines management information systems to help meet this challenge as well as tackling the increasing burden of chronic diseases.
Khayelitsha District Hospital is a large public facility located in the heart of the Khayelitsha township, a focus area for the President’s Urban Renewal Programme (URP). The hospital forms the basis for the area’s healthcare sub-structure which includes eight clinics that collectively treat over 6,000 patients a day, many of whom are on chronic medication for conditions commonly associated with poverty.
The challenge around improving medicines usage within the Khayelitsha area was how to address stock outs, decrease outpatient waiting times and coordinate care on a regional basis. From the beginning, the hospital management team has recognised the need for eHealth to support their ambitions and has adopted the province’s regional medicines system to respond to these challenges and improve workflows and safety.
Assistant Manager of Pharmaceutical Services for the Western Cape Government (WCG), Donovan Hopkins, explained that the JAC platform was chosen as the primary medicines management system for the hospital because it was in line with the province’s eHealth strategy and had a proven track record of delivering benefits across multiple settings. “WCG’s strategy requires all clinics and hospitals in the province to use the JAC system to ensure we can take a regional approach to managing stock levels and improving patient centred care,” said Hopkins.
Due to the number of patients the Khayelitsha healthcare substructure treats daily and the volume of medicines being dispensed from their facilities it was crucial to eliminate the risk of stock outs. By using the data from the system, the pharmacy team could pre-plan to ensure the necessary stock was always going to be available. According to Hopkins, JAC’s system has made a marked improvement in understanding and forecasting how much stock a facility needs to carry.
Being able to accurately calculate and plan stock levels has allowed the hospital to monitor usage more precisely. “Now that we know what we are using, we’re aware of potential stock outs before they happen and are able to either order more in time or pull from other facilities,” said Hopkins.
The regional nature of the system allows all facilities in a sub-structure to view each other’s stock, which, according to Hopkins, “is extremely useful for dealing with either delays in supply or spikes in demand like during our vaccine campaigns. We can very quickly report on how much stock each facility is carrying and decide whether it needs to be shared with other clinics that are running low.”
There is also a financial benefit to having a detailed and accurate picture of the stock levels. “Prior to the system it was at best an estimate as to how much stock was used – we had to rely on calculators and best-guesses – which often meant carrying more stock than necessary just in case. Since using the system, we’ve seen a 30% reduction in the amount of stock we carry, which is a significant saving,” said Hopkins.
Time to make a difference
Waiting times throughout Khayelitsha’s sub-structure could be as much as eight hours before implementing the system. Hopkins credits JAC’s system for dramatically reducing waiting times at hospital and clinic facilities. Half of the patients treated daily collect pre-packaged medication parcels while the other half are dispensed through the JAC system after they have been seen by a doctor and receive a prescription. “Waiting times in the big clinics have dropped to under an hour, which is a great achievement in light of the overwhelming number of patients who require ARV and chronic medication,” said Hopkins.
The system has also enhanced the role of the pharmacists: “Over the years it became the norm for pharmacists to spend the majority of their time counting pills and all they saw were scripts. JAC’s system means that they can see much more information about the patient and their history so they can make more informed decisions and query prescriptions that are potentially unsafe,” said Hopkins.
By alleviating the administration burden and streamlining processes, “the system also allows them more time to focus on patient interaction and counselling, and more time to visit patients on the wards and provide valuable input at the bedside.”
A patient-centred approach
The system is not only improving efficiency in the pharmacy but on the wards too. “The system provides a comprehensive overview of the patient’s medications and history to see what treatment the patient is receiving,” said Hopkins.
However, the system’s potential functionality is currently underutilised. Additional modules for e-prescribing, e-recording of administrations and even more detailed budget management create an opportunity to do more by implementing these tools throughout clinics and hospitals to further streamline and support clinical processes.
“What we want is a system that allows doctors in the clinic to write electronic scripts that are linked directly to the pharmacy dispensing system and then back to the nurses on the wards. It won’t be without its challenges, we will need more hardware, network infrastructure and computer literacy among staff,” said Hopkins.
When doctors and nurses are able to quickly and easily view a patient’s medication, and have tools that plug orders and administrations straight into the pharmacy system, they will able to complete assessments faster, reduce time spent on ward rounds and spend more time with their patients.
Coordinating care across a region
To date, JAC’s system is the only proven system in South Africa that delivers a modern healthcare service on a regional basis. Implementing the system has improved efficiency, safety and savings throughout the Khayelitsha sub-structure and these benefits have been replicated many times at sites across the province.
Unfortunately, there is little accessible data from before the system was implemented, but this in itself is one of the benefits of the system. However, in a recent informal evaluation, the WC DoH believe they have realised significant benefits since using JAC’s platform including a reduction in costly dispensing errors, better accountability and audit of drug supplies, and improved patient outcomes. The system has also streamlined repeat prescriptions and monitoring of therapy compliance for complex and chronic illnesses across the province.
The DoH is also able to access centralised reporting of an individual facility or at a regional level for assistance in planning, financial audit and clinical review. Added to that, a single drug catalogue has been established across the region with ongoing formulary management tools in order to support rational prescribing initiatives and compliance with the Provincial Code List and Treatment Guidelines.
Quality data for quality care
Behind the functionality, the JAC system has gathered one of the more comprehensive data sets in the country. Data that the province believes can be used to steer further improvements in securing a stable medicines supply chain.
“The data gives us the necessary insights to make real progress in transforming the public health service which would not be possible without adequate information systems. One example of what we can do with good quality data is to predict and quantify medication needs more accurately and eliminate stock outs entirely by using that data when we engage with pharmaceutical suppliers,” said Hopkins.
Hopkins went on to explain how this type of big data at a regional or even national level would enable decision makers at all levels, whether management or clinical, to find meaningful insights into the problems that need to be tackled to deliver the vision of a high-quality, universally accessible health service. He points to the Western Cape’s 2030 strategy which sets out an ambition to combine the medicines data from JAC with other eHealth sources to create a broader business intelligence platform for the DoH.
An end to paper-based systems
Hopkins went on to conclude that he is pleased that the facility and sub-structure is moving away from being limited by paper-based systems. While still “paper light,” they now have the tools to support many more necessary healthcare functions electronically.
“JAC’s system enables a wealth of information that is far more efficient than paper and has dramatically improved service delivery and stock management among other things. While others consider paper-based system as the norm, that is behind us. Everyone here complains about having to write on paper when we have power outages and I think that shows the great strides we’ve made towards a modern healthcare service,” concluded Hopkins.